MEDICARE: BARBARA LAZ PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251N0400X	Neurology Physical Therapist	12120	FL
2	225100000X	Physical Therapist	PT12120	FL

General Provider Information

NPI Number	:	1609667062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA LAZ PT

Provider Business Mailing Address
First Line	:	4020 PARK ST N STE 101
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33709-4030
Country	:	US
Telephone Number	:	727-388-4688
Fax Number	:	727-388-6887

Provider Business Practice Location Address
First Line	:	4020 PARK ST N STE 101
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33709-4030
Country	:	US
Telephone Number	:	727-388-4688
Fax Number	:	727-388-6887

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2025
Last Update Date	:	05/15/2025

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Directions to “ BARBARA LAZ PT” Practice Location

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